You have been working as a nurse in the adult oncology unit for the past year. You have developed a close relationship with many of your patients, but Mr. Newcomb has a special place in your heart. He has been diagnosed with stage 4 pancreatic cancer and has undergone aggressive chemotherapy. Each day his wife has come to the unit to be with her husband. They have been married for over 40 years and share a deep love.

Mr. and Mrs. Newcomb have made the decision to no longer continue with treatment and have decided that hospice care is needed. Over the past few days, you have watched Mr. Newcomb’s health decline, and you can tell from your experience that he does not have much time left to live. Mr. Newcomb has been very open about discussing his death, and you have had the opportunity to learn about his life and the legacy he will leave behind.

While you are completing your rounds, you stop in Mr. Newcomb’s room to see how he is doing. You ask, “Is there anything else I can do for you?” Mr. Newcomb has rarely asked for anything, but today he has one request. Mr. Newcomb states, “Before I die, I would like to see my mistress one more time. Mrs. Newcomb is always here. Do you think you could tell her that I will be busy for a few hours tomorrow so I can make arrangements to see my mistress one more time?”

Reflect on the following questions before you begin working on this task:

•   What would you do in this scenario?

•   How can your knowledge of ethical principles be utilized to determine your response to Mr. Newcomb?

•   How would this affect you as a nurse and direct provider of care for Mr. Newcomb?

A.  Summarize how the principles of beneficence, non-maleficence, autonomy, and justice apply to the scenario by doing the following:

1.  Describe how you would respond to Mr. Newcomb’s request.

2.  Evaluate how you applied the principles of beneficence, non-maleficence, autonomy, and justice to the scenario.

3.  Examine how personal beliefs and values influenced your response to the scenario.

4.  Describe three strategies to promote self-care.

Cystic Fibrosis

Cystic fibrosis (CF) is a prevalent autosomal disease caused by autosomal passive alleles. Alles are different kinds of genes located at the same locus on the chromosome (McCance and Huether, 2019). Cystic fibrosis is a life-limiting autosomal recessive disease that affects around 30,000 people in the U.S. and 70,000 around the world (Peters, 2014). It is the most commonly known deadly disease in white children, occurs at about 1 in every 2500 births, and about 1 in every 25 whites carries a duplicate of the allele that can cause cystic fibrosis (McCance and Huether, 2019). In various organ systems, most commonly gastrointestinal, pneumonic and genitourinary, this hereditary problem causes the collection or accumulation of thick gooey discharges. The affected individuals usually battle recurrent respiratory infections, pancreatic insufficiency, and malnutrition. The transpiration or sweat glands are also affected.

Pathophysiology

Cystic fibrosis is caused by a change in the quality of the cystic fibrosis transmembrane conductance controller (CFTR) (Brown, White, and Tobin, 2017). The movement of chloride and sodium particles across epithelial cell layers or membranes is regulated by the CFTR generated by this gene. The cystic fibrosis gene encodes a protein product that forms chloride channels in the membranes of specific epithelial cells, as per McCance and Huether (2019). CFTR transports proteins through membranes and works with the epithelial sodium channels simultaneously to maintain the balance of salt, fluid and PH in different epithelial membranes. Impairment in the transport of chloride ions causes a salt imbalance that leads to anomalous, thick and dehydrated discharges of mucus or body fluid. Approximately 1,900 CFTR mutations have been recognized as indicated by Peters (2014). F508del, with heterozygotes and homozygotes making up 87 percent and 47 percent of patients with cystic fibrosis, is the most commonly known mutation. According to McCance and Huether (2019), associations (marriage between related individuals or people) is a factor in the creation of offspring with recessive diseases or sickness, such as cystic fibrosis. This is on the basis that related individuals or persons are bound to have similar alleles that cause recessive disease.

The patient showed the side effects of colic, an inability to gain weight despite having a good appetite, a salty taste, a chest clog, and pneumonia, as indicated in the case study. These introductions are due to a defect in the transport of chloride ions and a salt imbalance that causes abnormally thick mucus or body fluid secretions in the various secretive glands. They cause colic, distension, malabsorption, inability to thrive, and meconium ileus in newborn children to the point where secretions accumulate in the digestive tract (Brown, White, and Tobin, 2017). It can hinder the pancreas, leading to a lack of healthy sustenance. With mucus-inducing cough, wheezing, dyspnea, chest clog, and pneumonia, the lungs may be hindered. An undescended testicle, congenital bilateral absence of vas deferens and infertility in women are part of the genitourinary presentation.

Genetic Factor

Genes are the essential hereditary units within a cell nucleus known as chromosomes. There are 46 chromosomes in each person, 23 taken from each parent. In CF, each parent carries one anomaly CF gene and one normal CF gene, but due to the fact that the normal CF gene dominates the abnormal CF gene, the disease does not appear. In order to have CF, the child must acquire two abnormal CF genes, one from each parent. Since it is a non-sex-connected chromosome, CF can also occur in both males and females. Parents of children with autosomal recessive diseases, for example, CF is a heterozygous carrier of the genes of the disease, so there is a risk of 25 per cent of disease or disease in other children. Before considering having children, at-risk parents should seek hereditary advice. In the case of an increasing number of autosomal recessive hereditary or genetic diseases, parents may also benefit from Carrier detection tests.

Diagnosis and Treatment

The diagnosis of CF is made by means of a screening test for infants or newborns. A regular sweat test is performed to give a full diagnosis of CF if the test is positive for CF. The management of CF depends on the severity and progression of the disease. These include breathing, immunization, symptomatic therapy, non-intrusive therapy, physical therapy, exercise, and medication therapy (Brown, White, and Tobin, 2017). Other measures of physiotherapy, such as chest percussion and breathing, are often carried out with the ultimate aim of expanding and draining secretions from the lungs. In some extreme cases, lung transplantation may be considered (Mikesell, 2019). Dietary supplementation by prescription, diet and vitamins improves nutrition. In most cases, numerous antimicrobials and enzyme replacements are consistently used in the treatment of CF patients.

Conclusion

Cystic fibrosis is an inherited multisystem disease that affects the function of CFTR, resulting in chronic pulmonary disease, gastrointestinal interference, and the blocking of exocrine organs or glands. In Caucasians, CF predominates over other ethnic groups, approximately 1 in 3500 in North America and Europe, and new cases are analyzed annually (McCance & Huether, 2019). Diagnosis depends on the clinical indication and laboratory findings of the sweat test. It is important to maintain a follow-up appointment with the healthcare provider and management team due to the nature and complications of the disease.

References

Brown, S. D., White, R., & Tobin, P. (2017). Keep them breathing: Cystic fibrosis pathophysiology diagnosis and treatment. Journal of The American Academy of Physician Assistants, 30(5): 23-28. Retrieved from https://dx.doi.org.ezp.waldenulibrary.org/10.1097/01.JAA0000515540.36581.92Links to an external site.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Mikesell, H. F. M. (2019). Cystic fibrosis and genetics. Salem Press Encyclopedia of Health.

Retrieved December 2, 2020 from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=94416438&site=eds-live&scope=site

Peters, S. (2014). Cystic fibrosis: A review of pathophysiology and current treatment recommendations. The Journal of the South Dakota State Medical Association, 67(4): 148-51, 153. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/detail?vid=5&sid=81561ef6-823c-4415-9f10-d7568752e3f9%40sessionmgr4008&bdata=JnNpdGU9ZWhvc3QtbGI2ZSZzY29Wzt1zaXRILinks to an external site.

Case: Adolescent white male without health insurance seeking medical care for STI

· How would your communication and interview techniques for building a health history differ with each patient?

· How might you target your questions for building a health history based on the patient’s social determinants of health?

· What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?

· Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.

· Select  one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the  Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.

· Develop  at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Apa and at least 3 resources must be scholar resources

Think back to the beginning of the course and consider your thoughts on learning about nursing theory. Did you question the usefulness of spending a term learning about theory? Next, consider your current practice environment now that you know more about theory. Is theory used in practice, or is there a theory practice gap that needs to be addressed?

• If you think theory is known and used in practice, support your view with evidence.
• If you think a theory – practice gap exists, support your view with evidence.

Additional tips and instructions:

I am a registered nurse; the discussion post should be only a page long. APA style. 3 references must be used, from the year 2015 and beyond. Below ill provide the grading rubric for discussions.

The Week 3 Activity “Help With Completing the Divine Roles Across Cultures Assignment” can be found in Week 3 Course Content.

Complete the Divine Roles Across Cultures Worksheet. Please note: You must select two different divinities from two different cultures who share the same role. For example: Ares from Greek culture, Odin from Norse culture sharing the role of Divinity of War. Please don’t select Zeus and Odin.